Provider Demographics
NPI:1013507250
Name:MCCORKLE, KATHERINE (CAS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MCCORKLE
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W PARKWAY LN
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3678
Mailing Address - Country:US
Mailing Address - Phone:719-688-7570
Mailing Address - Fax:
Practice Address - Street 1:1515 W PARKWAY LN
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3678
Practice Address - Country:US
Practice Address - Phone:719-688-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC0997394101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)